Adherence to biologic therapies and associated factors in rheumatoid arthritis, spondyloarthritis and psoriatic arthritis: a systematic literature review.

OBJECTIVES: To analyse the evidence on adherence to biologic therapies in rheumatoid arthris (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA). METHODS: Systematic review of studies retrieved by a sensitive search strategy in MEDLINE database (1961 through March 2012). To be selected, studies had to include patients with RA, SpA, or PsA, treatment with intravenous or subcutaneous biologic therapies, and had to report on measures of adherence. By design, only randomised controlled trials (RCT) or high quality cohort studies with a control group were selected. RESULTS: A total of 24 studies were included, of which 12 reported results from national or local biologic registers, 9 were retrospective studies, 2 prospective studies, and only one was an RCT. Patients included were mostly women with diagnosis of RA or SpA and, less frequently, PsA. There was a great variability in the definition of adherence, measurement methods, and associated factors analysed. In general, adherence to etanercept was superior to that of other biologics, by the measures utilised. The main predictive factors - age, sex, comorbidity, baseline clinical condition, previous or concomitant use of DMARDs, anti-TNF in monotherapy or in combination with MTX - produced diverse, even divergent results across studies. CONCLUSIONS: There is a wide variability related to the adherence concept and its measurement, reflecting the complexity of the phenomenon. In order to draw more consistent conclusions about the relative value of predictive factors on adherence and persistence of biological therapy, larger controlled studies with better selection of variables and analysis of interactions are needed.

[Cognitive assessment in the elderly. Normative data of a Spanish population sample older than 70 years]. / Evaluación cognitiva del anciano. Datos normativos de una muestra poblacional española de más de 70 años.

BACKGROUND AND OBJECTIVE: To define the parameters of normal cognitive performance in an easy to administer neuropsychological battery of a Spanish population sample of elderly over 70 years. SUBJECTS AND METHOD: We examined 527 home dwelling elderly from the longitudinal study Envejecer en Leganés, 71 to 99 years old (mean age [SD] 79 [6.2] years, 51.8% women, 38.7% without formal education), with an extensive clinical survey, a neurological exam and the following neuropsychological battery: Short Portable Mental Status Questionnaire, Mini Mental State Examination, Benton Orientation Test, Bell Test, Verbal Fluency, Clock Drawing Test, Trail Making Test, Free and Cued Figures Recall, Logic Memory, Naming, incidental Recall, Delayed Recall, Similarities, IQCODE Questionnaire Of Jorm and Depression Questionnaire CES-D. 111 cases who rejected the assessment or had sensomotor limitations were excluded. 368 non demented subjects (according to DSM-IV criteria; 88.5% of the de 416 remaining cases) were selected to establish the normative data of every test. RESULTS: The analyzed subsample was representative of the total sample. The normative data for every neuropsychological test were obtained in the total group of non demented subjects and in the subgroups stratified by four age levels and two cultural levels. The mean values, standard deviations, range and percentiles for every test and subgroup are presented. CONCLUSIONS: The normative data obtained in this population sample for a neuropsychological battery easy to administer to poorly educated elderly can be useful to rigourously apply the criteria of dementia and mild cognitive impairment in future clinical and population studies.